The Downside of Breast Cancer Screening

Excerpt:

“A 17-year study has concluded that screening mammography — in which all women in certain age groups are routinely screened for breast cancer — does not reduce the incidence of advanced tumors, but does increase the diagnosis of lesions that would never have led to health problems.

“In Denmark, screening was implemented in different regions at different times, so researchers there were able to compare groups of women who were screened with those who were not.”

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Notifications About Dense Breasts Can Be Hard to Interpret

Excerpt:

“About 40 percent of women who have mammograms are found to have dense breast tissue, a normal finding that can make it harder to detect cancer. But many of these women receive letters in the mail about the finding that can be hard to decipher, a new study found.

“ ‘Twenty percent of the population only reads at an eighth-grade level, and many more don’t read at a much higher level than that,’ said Nancy R. Kressin, one of the study’s authors who is a professor at Boston University School of Medicine and a senior researcher at the Veterans Affairs Boston Healthcare System.

“ ‘For many women, these notifications are not going to be easy to read’ and might even be alarming, she said. ‘We’ve talked to some women who received these letters, and their reaction was “Oh my God, I have cancer.” ‘ ”

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Mammograms to Screen for Breast Cancer Could Also Give Clues to Heart Disease Risk

Excerpt:

“Mammograms performed to check the health of the breasts could also give clues to the health of the heart, researchers say.

“That’s because the amount of calcium in the arteries of the breast, which can be seen on a digital mammogram, seems to reflect the amount of calcium in the coronary arteries, which supply blood to the heart.

“Although women are commonly screened for breast cancer with mammography, there is no routine screening test for heart disease. Calcium in the coronary arteries is known to be an early sign of heart disease. Finding a link between calcium in the breast arteries and calcium in the coronary arteries is a reason to ‘pay attention,’ study coauthor Dr. Jagat Narula from the Icahn School of Medicine at Mount Sinai in New York City told Reuters Health by email.”

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Mammograms May Not Reduce Breast Cancer Deaths

“Breast cancer screenings may not lead to fewer deaths but may lead to overdiagnosis, U.S. researchers suggest.

“In areas of the U.S. with high levels of screening, more tumors were diagnosed – but breast cancer death rates were no lower than in areas with fewer screenings, researchers report.

” ‘The mortality results that we observed are far from definitive,’ cautioned Charles Harding, the study’s lead author from Seattle, Washington.

” ‘The most dramatic finding of our study is the immediately evident – and substantial – evidence of breast cancer overdiagnosis,’ he told Reuters Health in an email.”


Study Suggests Dense Breast Tissue Isn’t Always a High Cancer Risk

“A new study offers help to patients and doctors who are trying to deal with mammogram results that many women consider troubling and confusing: the finding of ‘dense’ breast tissue.

“Not only is breast density linked to an increased risk of cancer, it also makes cancer harder to detect because dense tissue can hide tumors from X-rays. But the new research indicates that not all women with dense breasts are at very high risk.

“Patient advocates urge women with dense breasts to ask doctors about extra tests like ultrasound or an M.R.I. to check for tumors that mammography might have missed. Studies have found that those exams can improve detection of tumors over mammography alone in dense breasts.

“Pressed by advocacy groups, 22 states have passed laws requiring that breast density be reported to mammography patients, and similar federal legislation has been introduced in the House and the Senate.”


90 Percent of All Breast Cancers Can Be Detected with MRI

“Around 90 per cent of all breast cancers can be definitively diagnosed using magnetic resonance imaging (MRI). This compares to the combined methods of mammography and ultrasound which yielded a detection rate of just 37.5 per cent. This is the key finding of a study published in the highly respected Journal of Clinical Oncology. The study was carried out at the University Department of Radiology and Nuclear Medicine at the MedUni Vienna in cooperation with the University Department of Gynaecology and Obstetrics and the Clinical Institute of Pathology.

” ‘In cases where there is even the slightest doubt, and especially in women at increased risk, the obvious choice is MRI. Our study clearly shows the superiority of magnetic resonance imaging over mammography and breast ultrasound examinations,’ says Thomas Helbich, who led the study with Christopher Riedl. “The superiority of MRI is also completely independent of the patient’s age, gene mutation status and breast density.”

“In 559 women at increased risk, a total of 1,365 screening examinations were carried out. There was one clear ‘winner’: 90 per cent of all breast cancers can be clearly detected by MRI. The combination of MRI and mammography increased the detection rate by just five per cent. None of the cancers were detected by ultrasound alone. The results were similar for non-invasive cancers and for benign breast lesions.”


MRI Screening More Sensitive Than Mammography and Ultrasound for Familial Breast Cancer Irrespective of Age, Mutation Status, or Breast Density

“In a single-center study reported in the Journal of Clinical Oncology, Riedl et al found that screening with magnetic resonance imaging (MRI) had greater sensitivity for detection of breast cancer in high-risk women vs mammography or ultrasound irrespective of age, mutation status, or breast density. The addition of mammography or ultrasound added little to the sensitivity of MRI.

“In the study, BRCA mutation carriers and women with a high familial risk (> 20% lifetime risk) for breast cancer were offered screening with mammography, ultrasound, and MRI every 12 months at the Medical University of Vienna. Overall, 559 women with 1,365 complete imaging rounds were included in the analyses. There were 204 suspicious findings (15%). Of these, 38 (19%) were malignant; two additional cancers were found during the study period, including one identified by patient-requested biopsy and one interval cancer…

“The investigators concluded: ‘MRI allows early detection of familial breast cancer regardless of patient age, breast density, or risk status. The added value of mammography is limited, and there is no added value of ultrasound in women undergoing MRI for screening.’ ”


Ultrasound Lags behind MRI for Supplemental Breast Cancer Screening

“Cancer screening of women with dense breast tissue is a subject of great interest to both the medical community and the press. Dense parenchyma reduces the sensitivity of mammography to half that of fatty breasts. Approximately 40% of women 40 years of age or older have dense breast tissue, making supplemental breast cancer screening essential.

“Although supplemental screening via ultrasound is unaffected by breast density, is not associated with ionizing radiation, and does not require IV contrast material, acceptance of this modality has lagged.

“According to Ellen B. Mendelson, professor of radiology at Northwestern University Feinberg School of Medicine, and Wendie A. Berg, professor of radiology at Magee-Womens Hospital of UPMC, a significant factor is lack of available intensive training opportunities.

” ‘The most common alternative screening modality, MRI, cannot be used with women who have pacemakers or other devices, severe claustrophobia, or renal insufficiency,’ say Drs. Mendelson and Berg. To realize ultrasound’s potential to increase the number of cancers detected, intensive training programs need to be put in place for physician performers and interpreters for both handheld and automated breast ultrasound systems.’ “


Better Mammography Technique for Women with Dense Breast Tissue

“A new breast imaging technique pioneered at Mayo Clinic nearly quadruples detection rates of invasive breast cancers in women with dense breast tissue, according to the results of a major study published this week in the American Journal of Roentgenology.

“Molecular Breast Imaging (MBI) is a supplemental imaging technology designed to find tumors that would otherwise be obscured by surrounding dense breast tissue on a mammogram. Tumors and dense breast tissue can both appear white on a mammogram, making tumors indistinguishable from background tissue in women with dense breasts. About half of all screening-aged women have dense breast tissue, according to Deborah Rhodes, M.D., a Mayo Clinic Breast Clinic physician and the senior author of this study.

“MBI increased the detection rate of invasive breast cancers by more than 360 percent when used in addition to regular screening mammography, according to the study. MBI uses small, semiconductor-based gamma cameras to image the breast following injection of a radiotracer that tumors absorb avidly. Unlike conventional breast imaging techniques, such as mammography and ultrasound, MBI exploits the different behavior of tumors relative to background tissue, producing a functional image of the breast that can detect tumors not seen on mammography.”